Sleep disorders in hospitalized adults: Evaluation and management
- Dennis Auckley, MD
Dennis Auckley, MD
- Associate Professor of Medicine
- Case Western Reserve University (MetroHealth Medical Center)
- Section Editors
- Ruth Benca, MD, PhD
Ruth Benca, MD, PhD
- Section Editor — Insomnia
- Professor and Chair, Department of Psychiatry and Human Behavior
- University of California, Irvine
- Nancy Collop, MD
Nancy Collop, MD
- Editor-in-Chief — Sleep Medicine
- Section Editor — Sleep Related Breathing Disorders
- Professor of Medicine and Neurology
- Director, Emory Sleep Center, Emory University
Sleep-related breathing disorders such as obstructive sleep apnea (OSA) and central sleep apnea (CSA) occur with increased frequency in certain inpatient populations and may be associated with worse short-term outcomes. OSA is also common in the general population, is often undiagnosed, and may be first recognized in the inpatient setting. These and other primary sleep disorders are important to recognize, as acute illness and other aspects of hospital admission may aggravate chronic symptoms or bring to light previously unrecognized symptoms.
This review will discuss the evaluation, consequences, and management of sleep disorders in hospitalized adults. An approach to poor sleep in the inpatient setting is reviewed separately. (See "Poor sleep in the hospital: Contributing factors and interventions".)
OBSTRUCTIVE SLEEP APNEA
Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder, and most patients are undiagnosed. OSA may be first recognized in the inpatient setting, when sleep is directly observed and continuous hemodynamic and respiratory monitoring reveal breathing pauses and intermittent hypoxemia.
Prevalence — The estimated prevalence of OSA in the general population is approximately 15 percent in males and 5 percent in females . OSA is significantly under-recognized in the outpatient setting [2,3], and most patients are undiagnosed . (See "Overview of obstructive sleep apnea in adults", section on 'Epidemiology'.)
The prevalence of OSA in the general inpatient population has not been well studied but it is likely to be even higher than in the general population, as the inpatient population is enriched with comorbid conditions associated with OSA, such as obesity, diabetes, hypertension, and cardiovascular diseases [5,6]. Studies using screening questionnaires have found that 40 percent of inpatients ≥50 years old and 87 percent of inpatients with a body mass index (BMI) ≥30 kg/m2 score as high risk for OSA [7,8].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- OBSTRUCTIVE SLEEP APNEA
- Evaluation and diagnosis in the inpatient setting
- - History and physical exam
- - Screening questionnaires
- - Overnight oximetry
- - Portable sleep apnea testing
- - Polysomnography
- Adverse inpatient outcomes
- - Patients with known OSA who use PAP at home
- - Patients with known OSA who use other therapies at home
- - Patients with newly diagnosed or previously untreated OSA
- - Review of concomitant medications
- - Role of nocturnal oxygen
- Post-discharge follow-up
- CENTRAL SLEEP APNEA
- High-risk groups
- Diagnosis in the inpatient setting
- Potential consequences
- - Patients with chronic insomnia
- - Patients with new insomnia in the hospital
- OTHER SLEEP DISORDERS
- SUMMARY AND RECOMMENDATIONS